A review of practice in the implementation of the early language development support element within Flying Start

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A review of practice in the implementation of

the early language development support

element within Flying Start

Ymchwil gymdeithasol Social research

Number 62/2014

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A review of practice in the implementation of the early

language development support element within Flying

Start

May 2014

Arad Research in partnership with the National Centre

for Language and Literacy (University of Reading)

Hefin Thomas, Jennifer Lane, Jennifer Evans and Professor Viv Edwards

Views expressed in this report are those of the researcher and not necessarily

those of the Welsh Government.

For further information please contact:

Hayley Collicott

Children, Young People and Families Division

Welsh Government

Cathays Park Cardiff

CF10 3NQ

Tel: 029 2082 3111

Email: [email protected].

Welsh Government Social Research, 28 May 2014

ISBN 978-1-4734-1524-9

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1 Executive summary

Introduction to the review

1. Arad Research, working in partnership with the National Centre for

Language and Literacy based at the University of Reading, was

commissioned to conduct a review of current practice in relation to early

language development (ELD) interventions within Flying Start.1

2. The findings of this review of practice are intended to help shape

guidance associated with the early language development entitlement of

the Flying Start programme. Flying Start is a Welsh Government

flagship programme targeted at families with children aged between

nought and three living in some of the most disadvantaged communities

in Wales.

Methodology

3. The methodology for the review involved a mixture of qualitative and

quantitative methods. This mixed methods approach was chosen to

enable data to be gathered from all local authorities whilst also

collecting more detailed information and views in a smaller number of

areas. The approach included desk research and analysis of information

from all local authorities2, an electronic survey of all Flying Start teams,

fieldwork with Flying Start staff and parents in selected local authorities

and a group discussion with Speech and Language Therapists (SLTs).

4. The electronic survey was designed to collect data and views from all

the local authority Flying Start teams. At the same time, the qualitative

fieldwork with Flying Start staff and parents enabled more detailed views

on the ELD entitlement to be collected. All fieldwork was carried out

between December 2013 and February 2014.

1

Although there is not a standard definition of ELD services/activities, in this report we define them broadly as those activities that are most related to the ELD entitlement. These include, Language and Play groups, one-to-one sessions delivered by SLTs and other professionals; group and one-to-one ELD activities within other settings (e.g. Childcare settings, Health Visitor clinics).

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Models and Structure of Delivery

5. The type and structure of ELD provision offered by local authorities was

examined during the review. Different types of delivery included

universally available ELD activities, more targeted ELD activities and

ELD activities where delivery is embedded within other Flying Start

entitlements. The links between Flying Start ELD activity and generic

Language and Play/Number and Play (LAP/NAP) provision (i.e. that

which is provided across the whole of Wales rather than only in Flying

Start areas) were also considered during the review.

6. The review found that the delivery of universal ELD provision (e.g. LAP

groups), whilst important, is not sufficient to reach all families and

particularly those in high need groups. To ensure that more families

access ELD activities, greater emphasis should be placed on

embedding ELD across all entitlements. This requires ELD activities to

be regularly delivered within other settings. This also requires clear and

consistent modelling of good practice in adult-child interaction by staff.

7. The role of SLTs in shaping the delivery of ELD activities and providing

advice and guidance to other professionals was considered to be

important. Flying Start staff outlined the value of regular sessions with

SLTs to be able to raise queries and share experiences.

Awareness and Understanding

8. The review considered the views of Flying Start staff in terms of their

perceptions of levels of parental awareness and understanding of ELD.

Flying Start staff who participated in fieldwork reported that awareness

and understanding of the ELD entitlement and the benefits of activities

to develop ELD were low among parents. This was particularly the case

among high need families who are less engaged in universal ELD

activities (e.g. Language and Play groups). This reinforces the findings

of qualitative research undertaken as part of the National Evaluation of

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of the programme ... because parents failed to understand the ‘point’ of LAP, often not understanding how it would help’ (p. 49, Welsh

Government, 2013c).

9. During the review, local authorities provided information on their

approaches to raise awareness and understanding of ELD among

parents. Much of the activity highlighted was focused on raising parental

awareness of ELD activities. Less emphasis was placed on promoting

the benefits of ELD to parents. The evidence suggested that a greater focus was placed on embedding messages within activities. This ‘soft promotion’ of ELD across entitlements was considered to be an effective

approach to overcome parental reluctance to engage in ELD and should

be further developed.

10. Many practitioners provided suggestions to improve parental awareness

and understanding of the benefits of ELD. Local authorities outlined a

need for consistent and clear national messages relating to the key

milestones in ELD, good practice in adult-child interaction and the

benefits of ELD for child development. This could help ensure that more

information and activities relating to ELD are presented and delivered

within the other Flying Start entitlements.

11. The cross-cutting nature of the ELD entitlement requires all Flying Start

staff to have an understanding of these key messages and to promote

them across the other entitlements (e.g. in nurseries, during home

visits). The role of SLTs in raising the awareness and understanding of

ELD among staff is a crucial part of this process.

Engagement

12. The review considered how local authorities engaged families in ELD

and how barriers to engagement are addressed. Engagement was

defined as the process of getting families to take part in Flying Start ELD

activities and to maintain their participation. Identification and referral

processes for families with particular needs in terms of ELD were also

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13. The multi-disciplinary approach adopted by local authorities was

considered crucial to engaging families in ELD. This is particularly the

case for families with high needs. The relationships built by Health

Visitors and family support workers are vital in building trust with families

as well as encouraging and supporting them to access ELD services. This approach was considered important in creating a more ‘social’ and less ‘medical’ perception of SLT, which could improve the engagement

of high need families.

14. The importance of a multi-disciplinary approach was evident in how

local authorities create opportunities to engage families that are

reluctant to access ELD services. Approaches included ELD drop-in

sessions in Health Visitor waiting rooms, informal introductions to other

staff in childcare settings and personal one to one communication (face

to face as well as via text messaging). The promotion of such

approaches to engage families should be encouraged.

15. Clear referral processes are crucial to identifying the needs of children

and targeting them with appropriate services. The ability of Flying Start

staff to recognise ELD milestones and refer cases appropriately to SLTs

or other appropriate professionals is important. Similarly, the role of

SLTs in advising other staff on the appropriateness of referrals for

additional support is equally crucial.

16. Many staff proposed that engagement in ELD activity should begin

earlier, ideally at the ante-natal stage in order to build awareness and

encourage participation in ELD.

Screening and Assessment

17. The approaches taken by local authorities to identify, screen and assess

children in terms of ELD were considered during the review. As well as

being required to provide monitoring data to the Welsh Government on

children in their Flying Start areas, a variety of tools are used by local authorities to assess and identify children’s needs and to monitor their

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18. The use of appropriate screening and assessment tools was considered important in terms of identifying children’s needs and providing evidence

of progression. Staff welcomed the national use of the Schedule of

Growing Skills (SoGS) as a child development assessment tool whilst

acknowledging that it is not a specialist tool for assessing speech and

language development. Although in Flying Start universal training for

using SoGS is provided across Wales, many staff highlighted

inconsistencies in the tool’s implementation and considered that the

guidance for SoGS should be more prescriptive.

19. The Welsh Government outlined several measures that were being put in place to reinforce the national training including a ‘Trainer Network’

and regular communication to SoGS practitioners with further guidance.

20. The role of SLTs in providing advice and guidance on the use of

screening and assessment tools was considered important by Flying

Start staff.

Capacity and Training

21. The review considered the capacity levels of local authority Flying Start

teams to deliver the ELD entitlement as well as the amount and type of

training offered to staff within different roles.

22. The majority of local authorities employ SLTs as part of their core

teams. During visits, Flying Start co-ordinators emphasised the

importance of SLT capacity in the planning, delivery and monitoring of

the ELD entitlement. The role of SLTs in training and supporting other

professionals such as advisory teachers, LAP staff and childcare staff

was highly valued.

23. Flying Start co-ordinators and SLTs outlined a need for all staff to

receive basic ELD training including an understanding of ELD norms3

and good practice in adult-child interaction. The need for staff who

spend more time with children to participate in more detailed accredited

training was also highlighted.

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24. Many local authorities suggested that staff should receive continued

training or refresher courses to raise awareness of the importance of

ELD.

Recommendations

25. The following recommendations are made on the basis of the review:

i. The Welsh Government could consider developing a pack of

written and digital ELD resources, which could be used by all

local authorities to outline key messages relating to ELD and the

benefits of the entitlement. These messages would be applicable

for parents and staff. The development of these resources could

be led by a group consisting of individuals with a mixed set of

skills including SLTs, representatives of each of the entitlements

and a parent.

ii. The profile of the ELD entitlement within Flying Start should be

raised and it should be embedded as a cross-cutting entitlement

within the Flying Start Health Visitor service, parenting support

programmes and childcare. This could be achieved by

encouraging more information and activities relating to ELD to be

presented and delivered as part of the other Flying Start

entitlements.

iii. Information on the benefits of ELD and activities relating to the

entitlement should be promoted to all parents earlier starting at

the antenatal stage.

iv. Building on the examples highlighted in this report, notable

practice regarding activities that successfully engage high need

families in ELD activities should be identified and disseminated to

local authorities. This could be done via Flying Start co-ordinator

meetings or established regional SLT networks. Examples of

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parents during the ante-natal period, delivering one-to-one

sessions in the home and family support workers attending ELD

sessions with families.

v. All local authorities should employ SLTs as part of their core

teams, with a particular focus on the ELD entitlement.

vi. All Flying Start staff should receive a minimum level of training

relating to ELD norms and good practice in adult-child interaction.

This training should be overseen by a SLT.

vii. Flying Start childcare practitioners and other staff who deliver

ELD provision directly to children should be encouraged to

undertake more detailed training relating to ELD. Where possible,

this training should be accredited and planned by a SLT.

viii. All staff using screening and assessment tools should receive

training on the implementation of these tools to ensure that they

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2 Introduction to the Review

2.1 Arad Research, working in partnership with the National Centre

for Language and Literacy based at the University of Reading,

was commissioned to conduct a review of current practice in

relation to early language development (ELD) interventions

within Flying Start.

2.2 This research was commissioned to inform future Flying Start

policy, and specifically guidance associated with the ELD

entitlement to the programme.

2.3 This report presents the findings of the review, which was

carried out between December 2013 and February 2014.

Flying Start

2.4 In 2006/7,

t

he Welsh Government launched the Flying Start

programme, which aims ‘to make a decisive difference to the life

chances of children aged under four in the areas in which it runs’ (p. 1, Welsh Government, 2009). The programme is an

area-based programme, geographically targeted to some of the

most disadvantaged areas of Wales and is universally available

to families with children aged nought to four in those areas.

Through early identification of the needs of these individual

families, the programme aims to improve children's language,

cognitive, social and emotional development and physical

health. By supporting children's development, the programme

aims in the longer term to reduce the number of people with

very poor skills, improve qualifications at the end of schooling

and increase employment prospects.

2.5 Flying Start is administered as a grant to local authorities to fund

provision for children and their families within selected target

areas. Provision delivered as part of the programme consists of

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Free, high quality, part-time childcare;

Intensive health visiting support;

Parenting support; and

Support for Early Language Development.

2.6 Families within the targeted areas have access to all the

entitlements of the Flying Start programme. Although the core

entitlements are universally available to families in the selected

areas, tailored support depending on individual families' needs

is an important aspect of the programme. These entitlements

delivered as a holistic package based on specific individual

family needs.

Management of Flying Start

2.7 Each local authority has a Flying Start co-ordinator who manages

a core team of staff delivering the programme. The members of

this core team differ across local authorities but may include:

Health Visitors; Parenting Workers; Childcare Workers;

Midwives; Speech and Language Therapists (SLTs); and

Language and Play Workers. The Flying Start Strategic

Guidance (Welsh Government, 2012a) recognises the important

roles that these various practitioners make to the programme.

2.8 As part of the Flying Start Strategic Guidance, the Flying Start

Financial Management Annex document (Welsh Government,

2012b) states the following:

‘The Welsh Government has allocated Flying Start funding to local authorities. Each local authority’s allocation covers its

own spending and that of its associated third party Flying

Start providers. Within the agreed totals, it has considerable

discretion over setting priorities to deliver the Flying Start

services for which it is responsible’ (p. 11).

2.9 Local authorities are required to submit their Flying Start budget

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demonstrates that the ELD budget was only a small proportion

of the overall Flying Start budget in all local authorities in

2012-13: ranging from 13.85 per cent to 0.7 per cent across local

authorities in Wales. This suggests that only a small proportion

of the grant provided to local authorities for the Flying Start

programme is used to fund ELD staffing and contract costs. The

data also indicates that the actual spend on the ELD entitlement

can vary when compared to the budget allocated: this ranged

from an overspend of 20 per cent in one local authority to an

underspend of 63 per cent in another in 2012-13.

Aim and objectives of the study

2.10 The overall aim of the project was to review current practice

across all 22 local authorities in Wales in relation to the

implementation of the ELD support entitlement within Flying

Start. The findings of this review will complement those of a

corresponding review of research evidence (Welsh

Government, 2014a) on early speech and language

interventions undertaken in parallel to this study. Both reports

will help inform Welsh Government Flying Start guidance

documents.

2.11 A number of other evaluation reports have been published over

the last five years (Welsh Government, 2010, 2011, 2013a,

2013b, 2013c, 2014b). One of these reports, Flying Start

qualitative research with high needs families (Welsh

Government, 2013c), highlighted the low uptake of Language

and Play (LAP) courses among families with high needs.4 It also

reported that the ELD entitlement was valued far less than other

elements of the Flying Start programme, attributing this

perception to parents’ lack of understanding of the benefits the

entitlement would bring to them and their children. The present

review of current practice therefore builds on this recent

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research and explores points that emerged from the recent

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3 Methodology

3.1 This section provides an overview of the methodology that was

used to conduct the review of current practice of the

implementation of the ELD entitlement within Flying Start.

Overview of the methodology

3.2 The review involved a mixture of qualitative and quantitative

methods including desk research and analysis of information

from local authorities5, an electronic survey of Flying Start

teams, fieldwork with Flying Start staff and parents in selected

local authorities and a group discussion with Speech and

Language Therapists (SLTs). Below we outline the rationale and

limitations of the methodology, whilst sections 3.7 to 3.13

provide an overview of these approaches.

3.3 The rationale for the mixed method approach outlined above

was to enable a breadth of information to be analysed from all

local authorities whilst undertaking more in depth research in a

smaller group of areas. The electronic survey was designed to

collect data and views from all the local authority Flying Start

teams. At the same time, the fieldwork with Flying Start staff and

parents enabled more detailed views on the ELD entitlement to

be collected.

3.4 To ensure a consistent approach, research themes identified

from the outset, and summarised in Table 1, provided a

framework both for the collection of data and for reporting the

findings of the review from section 4 onwards.

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[image:16.595.106.520.63.552.2]

Table 1. Overview of research themes and key questions for the

Review

Theme 1 – Models and structure of delivery

What LAP / ELD activities are offered and how are they structured?

What is the nature /structure of related activities through other Flying Start entitlements?

How tailored is the activity to the local needs?

What is the role of external partners in delivering activity? How are the needs of bilingual/ multilingual families addressed?

What is the relationship between generic LAP/NAP grant programme and ELD entitlement of Flying Start

Theme 2 – Parental awareness and understanding

How is information about LAP / the ELD entitlement provided to families in Flying Start areas? And by whom?

How do Health Visitors (and others) encourage parents to take up LAP services? How are the benefits of the services explained to families? How does this compare with Flying Start provision through other entitlements?

Theme 3 - Engagement

How is parental engagement encouraged? What are the referral plans and procedures?

What support do parents get to attend LAP courses (e.g. transport, childcare, etc.)?

Theme 4 – Screening and assessment

What are the assessment and identification tools used? How are needs assessed?

How is progress measured?

What other systems of assessing change are in place?

How are the outputs and outcomes of the service recorded and monitored?

Theme 5 - Training

What training is provided to staff delivering ELD provision?

How is it ensured that staff involved in delivering ELD provision have the required level of understanding of ELD?

How is staff’s level of understanding of ELD assessed?

Source: Arad Research

Limitations of the methodology

3.5 The methodology adopted for the review has provided valuable

insights into what Flying Start staff considered to be effective in

delivering the ELD entitlement. However, limited quantitative

evidence of the impact of different approaches is available to

lend greater weight to these perceptions. Furthermore, the

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has meant that more in-depth information from practitioners and

parents in other areas of Wales is not included.

3.6 The findings presented in this report are based on the views of

professionals, drawing on their knowledge and experience of

delivering ELD. These insights and views are valuable in

informing future approaches. It is important to note, however,

that there has been limited independent evaluation of the

methods and programmes currently in use across the local

authorities. This is reinforced in the findings from the

corresponding review of evidence report (Welsh Government,

2014a). Indeed, this was acknowledged by many of the SLTs

consulted during the review and may be an area for

consideration in future evaluations of Flying Start.

Desk research

3.7 The desk research consisted of a review of the background

documentation to gain an initial understanding of the ELD

activities and approaches being adopted and delivered through

the Flying Start programme across Wales. Documents that were reviewed included all local authorities’ Flying Start strategic and

delivery plans and data monitoring workbooks, which the local

authorities are required to submit to the Welsh Government.6

3.8 In addition to reviewing the above documentation, data collected

through Schedule of Growing Skills (SoGS) assessments, a tool used by all local authorities to assess children’s development

was analysed to establish any associations with the research

themes and key questions for the Review.

6

Within their Flying Start strategic plans, local authorities are required to outline their plans for the programme from 2012 to 2015. These plans focus on the four core elements of the

programme are submitted to the Welsh Government every three years. Local authorities are also required to submit deliver plans which outline any changes to the delivery of the

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Survey of Flying Start teams

3.9 In addition, Flying Start co-ordinators were invited to provide

details of the ELD entitlement within their local authority via an

email survey. Responses were received from all 22 local

authorities in January and February 2014. These responses

were reviewed and common themes were identified. The survey

pro forma is included in Annex 1.

Qualitative fieldwork with selected local authorities

3.10 To gain a more in depth understanding of the ELD provision

delivered within Flying Start areas and to identify examples of

good practice, visits to five local authorities were undertaken in

January and February 2014. These were selected to include: a

mix of urban and rural areas; a geographical spread across

Wales; an area with a high proportion of black and minority

ethnic (BME) families; and an area with a relatively high

proportion of Welsh speakers. The rationale for this approach

was to ensure that the sample of local authorities was as

representative of Wales as possible.

3.11 Table 2 below shows the five selected local authorities and the

[image:18.595.111.526.551.684.2]

rationale for their selection.

Table 2. Selected local authorities and rationale for their selection

Area Rationale

Cardiff South east Wales Urban area

Area with a high proportion of BME families Caerphilly Valleys area

Denbighshire North east Wales Ceredigion Mid-Wales

Rural area

Area with a relatively high proportion of Welsh speakers Conwy North-west Wales

Source: Arad Research

3.12 During the visits to the five local authorities, interviews or group

discussions were conducted with the Flying Start co-ordinator,

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Advisory Teachers, Childcare Workers, family support workers7,

Language and Play staff and primary school teachers, also took

place during visits8. Observations of ELD activities being

delivered by SLTs and other staff in various settings were also

undertaken in each area. These included baby LAP groups,

ELD activities in nurseries, one-to-one sessions in the home,

training for parents and training for staff. Informal discussions

with parents were also conducted following these activities. A

summary of the fieldwork undertaken in each area is included in

Annex 2.

Group discussion with Speech and Language Therapists (SLTs)

3.13 A focus group with seven SLTs was conducted to determine

their views on current ELD provision as part of Flying Start

across Wales and models of good practice. The SLTs taking

part in the focus group were from a wide range of local

authorities. In addition, participants included a representative

from the Royal College of Speech and Language Therapists

(RCSLT) and a SLT from Aneurin Bevan Health Board.

7

Although this is not a formally defined role in Flying Start guidance, several local authorities employ staff in a ‘family support worker’, ‘family worker’ or ‘family key worker’ role. In the local authorities visited during the fieldwork, this role appears to involve building relationships with a caseload of higher need families and engaging them in the community, often undertaking activities in the home with a view to eventually getting families to attend group sessions. 8

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4 Models and Structure of Delivery

4.1 The report on the delivery and implementation of Flying Start, as

part of the National Evaluation (Welsh Government, 2013a),

suggested that different models of delivering the ELD

entitlement could help improve parental engagement.

4.2 This section outlines the findings of the review in terms of the

type and structure of ELD provision offered by local authorities.

These include universally available ELD activities, more

targeted ELD activities and ELD activities where delivery is

embedded within other Flying Start entitlements.

Universally available ELD activities

4.3 The main ELD provision offered through Flying Start is

Language and Play (LAP) / Number and Play (NAP). All local

authorities offer LAP/NAP but structure its delivery in slightly

different ways. Some LAP/NAP provision is through group

sessions, often delivered in childcare or community settings,

and other provision is via one-to-one sessions, delivered in

centres or the family home. Most local authorities offer both

group sessions and one-to-one sessions. Whether families

attend group sessions or receive one-to-one sessions depends

on needs.

4.4 LAP sessions are often delivered in ‘drop-in’ sessions across

local authorities but are also offered as a course (usually 4-6

sessions) within the programme. Several Flying Start

co-ordinators and staff highlighted the challenge of getting parents

to commit to a set course of LAP sessions. Some Flying Start

staff considered drop-in provision to be more appealing to

parents and a way of reaching greater numbers of children.

4.5 In order to overcome barriers, such as the perception that LAP groups were too formal, several local authorities ‘branded’ these

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the review included ‘Laugh and Learn’, ‘Little Stars’, ‘Let’s Sing’ and ‘Singing Hands’.

4.6 Local authorities have adopted a multi-disciplinary approach to

delivering LAP, involving SLTs, assistant SLTs, advisory

teachers and other staff in the delivery of these sessions. Some

local authorities ensured that at least one member of staff

involved in delivering LAP in each setting had received training

from a SLT.

4.7 LAP sessions observed during the review involved a number of

methods of delivery with children from four months to three

years old. These included:

parents and children singing and reciting nursery rhymes in

a group (with lyric sheets provided by the local authorities);

families sitting in a circle with children taking turns to play

with various toys;

children listening to a practitioner reading a story;

children observing a puppet show; and

more informal play opportunities.

4.8 During all of the LAP sessions observed, SLTs and other staff

disseminated ideas to parents verbally and through written

materials, and encouraged parents to try these activities at

home. Staff also passed on tips for creating simple toys and

different play strategies that would encourage ELD. Some of the

groups observed offered opportunities for parents to borrow

books and other resources from the setting.

More targeted ELD programmes

4.9 Local authorities reported that, where children are identified as

having additional needs in terms of ELD, specific tailored

interventions are often planned by SLTs in partnership with

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SLTs in clinics or Flying Start centres or recommendations to

attend universal ELD sessions such as LAP.

4.10 Staff in local authorities also noted that SLTs often play a more

strategic role in planning interventions for family support

workers to deliver in the home. This could involve undertaking

initial assessments and setting targets for activities to be

delivered with the family. Flying Start co-ordinators emphasised

the important consultative role played by SLTs in planning and

overseeing interventions delivered by other staff as well as

providing guidance and support. This role was considered important because of SLTs’ knowledge of the most appropriate

programmes and interventions as well their ability to assess the

progress of children and advise how best to deliver activities.

Flying Start staff outlined how drawing on the expertise of SLTs

gave them greater confidence in delivering ELD interventions.

4.11 During this review, several local authorities reported that

parents of children in high need families were often reluctant to

engage with SLTs, or with targeted ELD support delivered by

other staff. It was considered important to explain what happens

in a clinical appointment with a SLT as a way of minimising the

number of missed appointments.

4.12 Flying Start co-ordinators and SLTs emphasised the different

approach to missed appointments in Flying Start areas. In

generic SLT services, missed appointments would lead to

children being discharged; it is not be possible for staff to

follow-up families because of a lack of capacity and absence of

consent. In Flying Start areas, the additional capacity and closer

working relationships within a multi-disciplinary team allow SLTs

to ask other staff (e.g. family support workers) to help follow-up

these families, leading to greater re-engagement with ELD services. One SLT noted that: ‘In Flying Start, there is more of a

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services is beneficial in engaging high need families through

Flying Start.

4.13 A range of speech and language programmes are used by local

authorities as part of structured activities for parents. Two

programmes cited in the National Evaluation of Flying Start and

mentioned frequently during this review are Elklan and Hanen.

Elklan is a speech and language programme that includes

training for practitioners and parents of children under five. The

Hanen Early Language Programme is a language development

programme used in a wide range of countries. In the context of

Flying Start, many local authorities have integrated these as

part of broader parenting support. Local authorities highlighted

the good feedback received from parents and staff who had

attended these courses and referred to anecdotal evidence of a

positive impact on staff confidence and enthusiasm. However,

they also noted that recruiting high need parents to take part

and maintain their attendance on ten week courses was very

challenging and, in many cases, unrealistic. This was because

many of these families had low confidence or motivation and

were reluctant to commit to attending this many sessions in

advance.

4.14 Several local authorities were focussing on shorter courses for

parents (two to four weeks) in order to try and improve take-up

and attendance. An example of a shorter course outlined by two local authorities was the Ican ‘Talk boost’ programme9

. Recently

introduced in one local authority, this two-week course was seen as ‘parent friendly’ because it involved four sessions over

a fortnight rather than ten sessions delivered over a couple of

months as with some other courses. It was therefore considered

easier to recruit parents and ensure they completed the course.

Staff reported that they had better levels of attendance on these

shorter courses.

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4.15 Many local authorities offer additional services which focus on

overall child development with an element of ELD within them. For example, one local authority described their ‘portage’ or

home visiting educational service for pre-school children with

additional needs. Similarly another local authority delivers

Parent as First Teacher (PAFT) sessions. PAFT focuses on children’s overall development by emphasising the importance

of parent child interaction through play. Although it aims to support children’s overall development, communication is a key

component.

Embedding ELD delivery within other entitlements

4.16 The importance of embedding the ELD entitlement across the

other three Flying Start entitlements was evident during the

review. The ELD entitlement of Flying Start is not delivered in

isolation from the other three Flying Start entitlements but

instead is embedded across the whole programme. The Flying

Start qualitative research with high need families report (Welsh

Government, 2013c) suggested that integrating LAP/NAP

activities within childcare or as part of parenting programmes

could help boost parental engagement. The evidence from this

review reinforces this conclusion, drawing on a number of

examples of local authorities incorporating ELD within childcare,

parenting and Health Visitor entitlements.

4.17 The review highlighted examples of how the Health Visiting

entitlement of Flying Start links with the ELD entitlement. Health Visitors are normally the family’s first point of contact within

Flying Start and provide information regarding ELD activities.

They also conduct initial assessments on the children, mainly

using the SoGS, and refer children to SLTs or other staff if

assessments identify additional needs. Section 6.9 below

outlines that, in one local authority, LAP sessions are delivered

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was considered by staff to be a successful approach to

engaging parents.

4.18 The delivery of ELD provision is also embedded within the

childcare entitlement of Flying Start. Several examples of SLTs

or advisory teachers delivering ELD interventions in nurseries

were encountered during the review. For example, in one local authority’s childcare settings, staff deliver a nine week ELD course entitled ‘First 100 words’ to targeted children.

Additionally LAP sessions are often delivered in childcare

settings.

4.19 In some local authorities, trained staff will visit childcare settings to promote ELD. For example, in one local authority ‘Key Family Workers’ run small group sessions to fulfil this role. In another

local authority, a team of advisory teachers visits childcare

settings to deliver ELD activities and model good practice to key

childcare workers. Targets are then set for key workers to

deliver specific ELD activities with individual children.

4.20 As well as delivering provision, staff within childcare settings will assess children’s language development and refer those

identified as being at risk. SLTs may visit childcare settings and

conduct speech and language assessments. They will provide

support to the childcare staff in delivering the ELD entitlement.

Often, if children are identified as having additional needs, play

plans are developed to support their ELD within the setting.

These play plans are often developed with the input of a SLT

and reviewed regularly by the childcare staff to monitor children’s progress. In some local authorities, Flying Start

childcare staff also receive ELD training e.g. Elklan (see section

8).

4.21 ELD messages are also embedded within parenting

programmes. For example a number of local authorities offer a parenting programme entitled ‘You Make the Difference’. This

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interacting with children, including how parents can positively support their child’s language development. Staff in one local

authority identified the Parents as First Teachers (PAFT) course

(see 6.14) as an effective way of embedding ELD within a

parenting course. PAFT focuses on teaching parents about child

development, and in particular brain development, and helping

them to talk, play and interact with their child. PAFT was viewed as offering a ‘non-threatening approach’ and that this therefore

made it easier to get parents involved. One staff member commented that ‘[The PAFT programme] is about changing the culture of how child interaction is viewed’.

4.22 Flying Start co-ordinators highlighted the importance of ensuring

that ELD is embedded across all the entitlements (i.e. that

information and activities relating to ELD are presented and

delivered within the other Flying Start entitlements) and that this

should inform future policy development. The evidence from this

review suggests that this is happening and is effective in

engaging parents. Multi-disciplinary working was considered to

be crucial in ensuring that this happens.

‘Liaison between all services in FS especially as children

move toward childcare settings is vital so that additional support can be put in place where difficulties are identified.’

Flying Start co-ordinator survey response.

Relationship between Flying Start and generic LAP / ELD provision

4.23 In addition to ELD provision delivered through Flying Start, all

local authorities receive a separate LAP grant to deliver

interventions across the whole local authority (i.e. in Flying Start

and non-Flying Start areas). The relationship between the

provision delivered through these funding streams was explored

during fieldwork with local authorities.

4.24 Survey responses from local authorities indicate that they have

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Start LAP/NAP provision. These include: delivering and

managing generic and Flying Start LAP/NAP separately;

delivering the same generic provision in both Flying Start and

non-Flying Start areas; and both Flying Start and generic staff

working in partnership within Flying Start areas with generic

services also offered in non-Flying Start areas. The evidence

gathered during the review is not suitable for evaluating whether

one approach is more or less effective than another.

4.25 Eight local authorities provided information in their survey

response to indicate that the LAP/NAP activities delivered in

Flying Start areas were managed and delivered separately to

those offered in non-Flying Start areas. In these local

authorities, greater levels of one-to-one LAP/NAP provision,

screening and assessment appeared to be offered in the Flying

Start areas.

4.26 Two local authorities noted that the same LAP provision was

delivered in both Flying Start and non-Flying Start areas. In one

of these areas, all LAP/NAP provision across the whole local

authority was managed by the generic service, with no Flying

Start funded LAP activities provided. In the other area,

LAP/NAP sessions were universally advertised to all families but

Flying Start families received a personal invitation to attend.

4.27 Four local authorities outlined that both Flying Start and generic

LAP/NAP were delivered in Flying Start areas whilst generic

LAP/NAP services were also delivered in non-Flying Start

areas. In these areas, Flying Start and generic staff tended to

work in partnership to deliver LAP sessions in the Flying Start

areas. In these local authorities, generic and Flying Start staff

tended to share resources (e.g. song sheets) and/or train

together. One local authority noted that

‘The [generic] NAP/LAP co-ordinator runs training courses

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local authority staff who work in any organisation involving children 0-4 years old, including Flying Start areas.’

4.28 The information provided by the other eight local authorities was

not sufficient to be able to outline differences in LAP/NAP in

Flying Start and non-Flying Start areas.

4.29 In general, survey responses from local authorities indicated that

greater levels of LAP/NAP provision were provided in Flying Start

areas compared to the generic services in non-Flying Start areas.

Survey responses indicated that there was a greater emphasis on

one-to-one sessions in the home and greater levels of screening

and assessment in Flying Start areas.

4.30 Five local authorities reported that they worked in partnership

with schools and/or libraries to deliver generic LAP/NAP services.

One local authority outlined how their generic LAP services were

focused on schools and on supporting the development of the adult’s key skills alongside their child.

4.31 One local authority noted that some generic LAP provision was

funded through the Families First programme. This tended to be

one-to-one LAP provision delivered in the home with families

progressing to universal LAP groups once they had been

engaged.

4.32 During the qualitative fieldwork, staff in some local authorities

reported that having different sources of funding for LAP meant

provision was not as co-ordinated or consistent as it could be. In

one local authority, the Flying Start co-ordinator outlined how all

staff delivering LAP in Flying Start areas were trained by and

worked closely with SLTs as part of a multi-disciplinary team.

However, this was not the case for staff delivering generic LAP in

other parts of the local authority. As a result, it was felt that the

generic LAP and Flying Start LAP provision were not being

delivered as consistently as they could be. Some co-ordinators

suggested that having one funding stream for ELD could be more

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Meeting the needs of bilingual / multilingual families

4.33 Local authorities outlined their approaches to addressing the

needs of bilingual and multilingual families in their survey

responses and during visits. These findings are outlined below.

Welsh-medium provision

4.34 In terms of Welsh-medium provision, approaches to address the

needs of families included:

assessing the language needs of families;

providing written information on provision through the medium

of Welsh and English;

offering specific Welsh language ELD sessions;

offering access to bilingual staff or SLTs;

ensuring one member of staff at each setting was able to

speak Welsh; and

delivering LAP/NAP sessions bilingually.

4.35 In addition to the above approaches, local authorities responding

to the survey mentioned that the Welsh language is embedded

within Flying Start provision. During visits conducted as part of

the review, this was observed in several settings through

incidental Welsh phrases, singing Welsh nursery rhymes or

providing Welsh-medium resources.

Provision in languages other than Welsh or English

4.36 In terms of other languages, approaches taken to address the

needs of bilingual/multilingual families included assessing the

language needs of families; providing information leaflets in

various languages; and providing access to

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4.37 Flying Start co-ordinators and SLTs in some areas emphasised

the importance of interpreters being culturally aware and having

some understanding on the topic area. It was noted that having a

contextual understanding of the purpose of a session was

important in order to pass on the messages that SLTs or other

staff were seeking to convey. Some staff reported for instance,

that translators did not always fully understand messages that

SLTs were trying to give. However, local authorities also

highlighted close working relationships with some translators and

having the opportunity to request specific interpreters.

Suggested improvements to delivery

4.38 Some SLTs proposed that a set of ‘design principles’ should be

developed at national level to underpin practice in LAP groups

and to help ensure that the quality of delivery was consistent

across Wales. These principles should include the key

messages that needed to be communicated during these

sessions regardless of how the groups are branded to parents.

4.39 Some Flying Start co-ordinators and SLTs proposed that the

Welsh Government could consider leading the development of

literature to market the importance of ELD in child development

to parents. It was noted that local authorities currently spend

significant sums of money on materials from commercial providers and that a process led by a national ‘task and finish’

group could help develop consistent messages aimed at

parents that could be used by all local authorities.

4.40 Flying Start co-ordinators in several areas proposed that more

emphasis should be placed on embedding ELD practice within

the other entitlements (e.g. childcare), as well as having

ELD-specific activities. Some Flying Start co-ordinators considered

that this could be a more efficient way of reaching a greater

number of children. Some co-ordinators also suggested that

current national monitoring arrangements did not fully recognise

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Monitoring the number of children participating in ELD activities

within entitlements was therefore suggested as a way of

encouraging local authorities to embed ELD across the

programme.

4.41 Flying Start co-ordinators and staff emphasised the need for

SLTs to be heavily involved in planning provision and providing

guidance and support to staff delivering activities. Some

proposed that there should be guidance on the recommended

number of children per SLT in Flying Start areas (see section 8

for further discussion on capacity and training).

Summary findings relating to models and structure of delivery

4.42 The delivery of universal ELD provision (e.g. LAP groups),

whilst important, is not sufficient to reach all families and

particularly those in high need groups. To ensure that more

families access ELD activities, greater emphasis should be

placed on embedding ELD across all entitlements. This requires

ELD activities to be regularly delivered within other settings.

This also requires clear and consistent modelling of good

practice in adult-child interaction by staff.

4.43 The role of SLTs in shaping the delivery of ELD activities and

providing advice and guidance to other professionals was

considered to be important. Staff outlined the value of regular

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5 Awareness and Understanding

5.1 Qualitative research undertaken as part of the National

Evaluation of Flying Start (Welsh Government, 2013c),

presented findings relating to parent awareness and

understanding of Language and Play activities and the ELD

entitlement of Flying Start. Language and Play was reported to be ‘much less appreciated by parents than other entitlements of

the programme ... because parents failed to understand the ‘point’ of LAP, often not understanding how it would help’ (p. 49,

Welsh Government, 2013c).

5.2 This section outlines the findings of the review of practice

relating to the awareness and understanding of ELD among

parents and staff. The impact national evaluation report (Welsh

Government, 2013b) states that

‘It is vital that the programme increases the awareness of,

referral to and take-up of Flying Start services in order to

achieve medium to longer term improvements to child and

parent outcomes. In this context, the take-up of key Flying Start entitlements has been considerable’ (p. 6).

5.3 Building on the findings from this report,the review considered

how aware parents and staff were of the importance of ELD; how local authorities raise parents’ awareness and

understanding of the ELD entitlement and associated services10;

and how the benefits of ELD activities could be better

communicated to parents. Findings relating to approaches for

engaging families in ELD activities are discussed in section 6.

10

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Parental awareness and understanding of ELD

5.4 During the qualitative research with local authorities, Flying Start staff were asked what they perceived to be parents’ levels of

awareness and understanding of the ELD entitlement. We

outline the findings based on these perceptions below.

5.5 In general, Flying Start staff who took part in qualitative

research during the review indicated that parental awareness

and understanding of the ELD entitlement and the services

provided through Flying Start were low. Survey responses

indicated that this presented a barrier to effective practice.

Figure 1 below shows that 16 out of the 22 local authorities who

completed the survey reported that low parental understanding

of ELD services was a barrier to effective practice. Additionally,

12 of the 22 local authorities reported that low parental

awareness of ELD services was a barrier to effective practice.

Interviews with Flying Start staff suggested that low levels of

parental awareness and understanding of ELD had an impact

on the value parents placed on ELD activities and consequently

on their willingness to engage in these activities. This suggests

that raising parental awareness and increasing understanding of

[image:33.595.130.526.527.732.2]

ELD activities are important in order to effectively support children’s ELD.

Figure 1. Barriers to effective practice to support ELD

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5.6 During visits to local authorities, Flying Start staff suggested that

parental awareness and understanding of the importance of language development need to be improved if children’s ELD is

to be effectively supported. Staff in several local authorities

reported that some parents did not consider themselves to have a significant role in their child’s ELD. Some staff also reported that some parents considered that their child’s ELD was the

responsibility of nurseries or schools. SLTs reinforced this

message, noting that raising parental awareness and

understanding of ELD should be a priority for local authorities across Wales. A SLT interviewed stated that ‘communication is not necessarily a high priority for some parents’.

5.7 The review’s findings suggest that communicating the benefit of

ELD activities to parents is important in order to improve their

understanding of the entitlement and, ultimately, their

engagement in ELD activities.

Staff awareness and understanding of ELD

5.8 The findings of the review suggest that awareness of ELD

among Flying Start staff in local authorities has increased in

recent years. A total of 20 out of the 22 local authorities

indicated in their survey response that they provide training to

staff in relation to ELD (see section 8). This training is generally

provided or overseen by SLTs and varies in its length and

nature depending on the role of the staff.

5.9 Flying Start co-ordinators and staff emphasised the important

role played by SLTs in raising the awareness and understanding

of ELD among staff. Several co-ordinators and staff noted that

key messages relating to ELD should be developed by SLTs

and communicated to staff. It was suggested that this could help

ensure that the knowledge and expertise of SLTs was

disseminated to other Flying Start staff. The role of SLTs in

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was also considered to be very important by Flying Start

co-ordinators and staff (see section 8).

5.10 Most Flying Start co-ordinators and SLTs that participated in the

fieldwork highlighted the need for consistent messages to be

communicated by all staff to parents regarding ELD. This included information on their child’s developmental milestones

relating to ELD, the important role of parents in ELD and how parents could support their child’s ELD. A discussion on

developing and disseminating more consistent messages on

ELD is presented in sections 4.39 above and 5.20-5.21 below.

5.11 Most Flying Start co-ordinators and SLTs emphasised that all

staff should follow good practice in adult-child interaction when

communicating with children in the presence of their parents.

They noted that consistent modelling of good practice by Flying

Start staff was vital to ensure that parents were more aware of how to support their child’s ELD. SLTs noted that consistency would also help ensure that parents were not ‘sent mixed

messages’ by different Flying Start staff. A discussion on how to

ensure consistent messages from staff to parents is included in

sections 4.39 and 5.20-5.21.

Approaches used to raise awareness of ELD activities

5.12 Local authorities provide information to parents about the

services that are available in various ways. Different types of

literature and information were highlighted in survey responses

and examples of these were provided during visits, including

information packs, leaflets, posters, booklets, newsletters and

parental case studies. This information was communicated in

various ways, for instance by post to Flying Start families, in

displays at Flying Start settings, and by staff during Flying Start

activities and sessions.

5.13 Electronic communication methods were also used to relay

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local authorities provided information on their website and some

use social media. Several Flying Start staff highlighted their use

of text messages to communicate with parents already engaged in Flying Start – both in terms of the ELD entitlement and

activities relating to the other Flying Start entitlements (see

section 6.18).

5.14 Flying Start co-ordinators, staff and SLTs highlighted the

importance of taking a multi-disciplinary approach to raising

awareness of ELD services. As well as ensuring consistent

messages, this was also seen as a way of encouraging families to follow a ‘pathway’ through different services (including ELD

and other Flying Start entitlements) and to remain engaged in

Flying Start activities. Some local authorities outlined the ‘pathways’ that were available to children and families to engage with services at different stages of a child’s

development. This was reflected in informal discussions with

several parents during the visits, who indicated that they had followed a ‘pathway’ by being signposted through several Flying Start activities (e.g. Health Visitor clinics leading to ‘Baby

massage’ and on to Baby Language and Play).

5.15 During visits to local authorities, co-ordinators outlined the

importance of their staff in raising awareness of ELD activities.

In general, Health Visitors were seen as the initial provider of

information for families. Within many Flying Start areas, they

provide families with an information pack which summarises

Flying Start entitlements and the services available. This pack

may include a timetable of ELD activities on offer.

5.16 Many local authorities commented on the importance of raising

awareness of ELD very early on, either directly through

midwives or through other staff at sessions run by midwives.

Providing information to parents during the antenatal stage was

considered an effective approach to raise awareness, with some

practitioners suggesting that parents were more receptive to

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engagement included SLTs or advisory teachers attending

antenatal sessions to discuss the importance of ELD, and to

encourage good parenting practice and attendance at ELD

group sessions. During a visit to one local authority, SLTs outlined how they had started to attend ‘Bump and Beyond’

antenatal sessions, working in partnership with midwives.

Although this was a relatively new development, staff hoped that

that this could increase the likelihood of those parents engaging

in ELD activities once their child had been born.

5.17 Although information provided by Flying Start team members

was considered important, many staff deemed word of mouth

from other parents to be one of the most effective approaches to

raising awareness of ELD provision and its benefits. It was

noted that parents were more likely to engage with services that

had been advocated by other parents.

5.18 With the importance of advocacy from other parents in mind,

Flying Start staff in one local authority outlined how they

advertise ELD provision by displaying posters which capture the

positive impact of the services in case studies of families who

have used them. These case studies included photos and

testimonials from families outlining their positive experiences of

participating in Flying Start activities.

5.19 In some areas, parents are encouraged to participate in courses

aimed at developing a more detailed understanding of ELD and

improving adult-child interaction. Parents who took part in the

research in one local authority outlined the benefits of taking part in the Elklan ‘Let’s Talk for Under 5s’ course. 11

These

included increased confidence and improved understanding of

different strategies for interacting with their child (e.g.

understanding the development of communication, different

types of play).

11

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Improving awareness of ELD

5.20 Many Flying Start co-ordinators and SLTs provided suggestions

on how to increase awareness of the ELD entitlement and the

benefits of the activities provided. These included:

developing a set of prescribed simple key messages relating to ELD at each stage of a child’s development, (e.g. the

number of words a child should know at the age of 18

months);

good practice in adult-child interaction (e.g. ideas for play or

dialogic reading); and

the benefits of ELD (e.g. improved literacy, behaviour and

social skills).

5.21 Several Flying Start co-ordinators and SLTs proposed that these ‘key messages’ should be developed at an all-Wales level

and then promoted consistently by all local authorities. It was

suggested that this would ensure that all Flying Start staff were

delivering accurate and consistent messages to promote the

benefits of ELD.

5.22 Several Flying Start co-ordinators, staff and SLTs noted that parents were more receptive to information on their child’s

development during the antenatal period. They therefore

suggested that greater efforts should be made to promote the

importance of ELD during the antenatal period. Suggestions for

doing this included: employing more midwives through Flying

Start; more Flying Start staff attending or co-delivering sessions

with midwives; and placing greater prominence on ELD within

antenatal information.

5.23 Staff in local authorities also suggested other approaches to

improve awareness of ELD among parents and staff. Some

highlighted a need for more ELD training and opportunities for

staff to raise queries with SLTs. Staff capacity and training

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Summary of findings relating to awareness and understanding

5.24 Awareness and understanding of the ELD entitlement and the

benefits of activities to develop ELD are low among parents,

particularly among high need families who are less engaged in

universal ELD activities.

5.25 Much of the activity highlighted by local authorities during the

review focused on raising parental awareness of ELD activities.

Less emphasis was placed on promoting the benefits of ELD to

parents than on raising awareness of the activities available.

The evidence suggested that a greater focus was placed on embedding messages within activities. This ‘soft promotion’ of

ELD across entitlements was considered to be an effective

approach to overcome parental reluctance to engage in ELD

and should be further developed.

5.26 Local authorities outlined a need for consistent and clear

national messages relating to the key milestones in ELD, good

practice in adult-child interaction and the benefits of ELD for

child development. This could improve the process of

embedding ELD across the other Flying Start entitlements.

5.27 The nature of the ELD entitlement requires all Flying Start staff

to have an understanding of these key messages and to

promote them across the other entitlements (e.g. in nurseries,

during home visits). The role of SLTs in raising the awareness

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6 Engagement

6.1 Engaging families in ELD activities is one of the main

challenges facing local authorities. This review defines

engagement as the process of getting families to take part in

Flying Start ELD activities and to maintain their participation.

6.2 Qualitative research as part of the National Evaluation of Flying

Start, (Welsh Government, 2013c), found that LAP did not appear to make ‘a lasting impression on many parents, and few

had tried to put what they had learned into practice on a regular basis’ (p. 51). Echoing this, a separate strand of the National

Evaluation, a report on the delivery and implementation of

Flying Start (Welsh Government, 2013a), found that the

increase in engagement in LAP activity was ‘less marked than that for each of the other entitlements’ (p. 26).

6.3 This section explores the approaches taken to engaging families

in ELD activities and to overcoming some of the barriers to

engagement. It also outlines some of the processes used to

identify families with particular needs in terms of ELD and the

referral processes that are in place to this end.

Levels of engagement in ELD activity

6.4 Many local authorities noted that family engagement with ELD

services was low. Reasons for low levels of engagement

outlined in section 5 above included low levels of awareness

and understanding about ELD and the services that are

available through Flying Start. Limited awareness of the

importance of both ELD and the role played by parents was also

frequently highlighted by Flying Start staff.

6.5 Flying Start co-ordinators, staff and SLTs also suggested a

number of reasons why levels of engagement in LAP courses

were low. These included a general reluctance among parents

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LAP groups were ‘too formal’ or ‘too posh’; a perceived stigma

associated with targeted support among some parents; and low

levels of confidence among some parents. These were reported

by Flying Start staff to be greater barriers among higher need

families and younger parents. One Flying Start co-ordinator

echoed the views of many practitioners who took part in the

research in noting that some parents questioned why they were

being offered ELD provision.

6.6 Older parents and parents that were part of a wider parental

peer group (i.e. who could attend with other parents they knew)

were reportedly more likely to attend LAP sessions. Some

parents that took part in discussions following a baby LAP

session noted that their confidence and willingness to attend a

drop-in LAP session had grown significantly over the years. One

parent noted that she would not previously have been confident

enough to sing to her child at home, and certainly not as part of

a group. Parents in other local authorities outlined how their

confidence to attend LAP sessions had increased following

initial engagement in other activities such as baby massage.

These initial courses had helped them gain confidence to attend

a group session and to get to know other parents in their area.

6.7 The barriers outlined above had led many of the local authorities

to adjust their approach to engaging parents, particularly those

from higher need groups. Some of the approaches encountered

during the review are outlined below.

Approaches to engage families in ELD activities

6.8 The report on the delivery and implementation of Flying Start, as